The Candidates on Health Care

While the Republican presidential candidates have been busy railing against Obamacare, the two leading contenders for the Democratic nomination have staked out radically different ideas on how to improve the American health care system.

Hillary Rodham Clinton has proposed adding useful consumer protections to the Affordable Care Act. Senator Bernie Sanders wants to create a single-payer system that would essentially expand Medicare to cover people of all ages.

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CreditJeannie Phan

Senator Sanders’s bold call for “a fundamental transformation of the American health care system” would look more like the plans in many other industrialized nations that often achieve better health outcomes at lower costs. His home state of Vermont flirted with the idea, but it dropped its plans because of fears that the high costs would harm the economy. A national program could be more cost-effective, but it has no chance of surmounting opposition from Republicans and from health care industries that fear their profits would be cut.

Mrs. Clinton vigorously defends the Affordable Care Act and its reliance on private insurance, but she would make important changes to protect people from co-payments and deductibles that have been rising faster than their wages. She would create a new tax credit of up to $5,000 to help families pay high out-of-pocket medical costs and would require insurers to cover three visits to the doctor each year before people start paying to meet their deductible.

Both Mrs. Clinton and Mr. Sanders have taken strong stands against the sometimes exorbitant prices for prescription drugs that manufacturers set with no reasonable justification. Both would authorize Medicare to negotiate with drug companies to drive down prices — a move now prohibited by law, at Republican insistence — and both would allow Americans to import cheaper drugs from other countries. Mrs. Clinton would cap a patient’s out-of-pocket drug spending at $250 a month.

The leading Republican candidates are unanimous in calling for repeal of the health care reform law — Donald Trump has called it a “catastrophe,” and Jeb Bush labeled it a “monstrosity.” Yet they are remarkably tongue-tied on how they would replace it.

In the Sept. 16 debate among 11 Republican candidates, the issue came up only obliquely. None of the Republican candidates have endorsed government negotiations with drug companies; they believe private negotiations and competition among drug companies are working just fine to curb drug costs.

Of the Republicans, only Senator Marco Rubio has sketched out an alternative to the current health system. He would rely on tax credits of unspecified amounts to help people buy private insurance — an approach that is comparable to what the Affordable Care Act does now but that would most likely be less generous. He needs to flesh out his plans and his competitors need to devise serious alternatives of their own so that voters can see how they compare with a reform law that is working remarkably well.